Ophthalmic Manifestations of Migraine in a Nigerian Tertiary Health Facility.

Background: Migraine is a group of headache syndromes, with a prevalence of 5%-25%. Migraine is a complex recurrent headache disorder, often unilateral, throbbing or pulsating in nature aggravated by physical activity, bright light, and loud noises. Symptoms associated with migraine without aura are nausea, anorexia, and varying degrees of ophthalmic problems ranging from visual aura, ocular symptoms, and ophthalmoplegia. Objectives: The study determined the pattern and ophthalmic manifestations of migraine in Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: This was an observational cross-sectional study. Ethical clearance was obtained from the research ethical committee of Aminu Kano Teaching Hospital (AKTH). A total of 254 patients diagnosed with migraine using international headache society criteria attending neurology clinic in AKTH were interviewed and examined using a structured questionnaire which captured the biodata, pattern of migraine and ocular symptoms associated with migraine. The data obtained were collated and analysed using Statistical Package for the Social Sciences, version 23. Results: Of the 254 patients examined, there were 95 (37.4%) males and 159 (62.6%) females, (M:F = 1:2) with mean age of 28.9 ± 9.7 years. Migraine without aura was the commonest type seen in 55.8% of patients. Most patients had unilateral headaches. About 52.8% and 57.5% had headaches that were throbbing in nature. The headache lasted for 72 h in 48.2% and 48 h in 30.3%. It was triggered by physical stress in 49.6% and lack of sleep in 46.5%. The commonest associated symptom was nausea in 44.9%, tinnitus in 39.0%, and vomiting in 29.1%. While the commonest ocular/visual symptom was photophobia in 76% of patients. Most of the patients had family history of migraine (62.8%). Migraine without aura (MWOA) was found to be significantly associated with female gender (P = 0.001; OR = 2.48; 95% CI: 1.45-4.25). Scotoma, fortifying spectra were significantly associated with migraine with aura (MWA; P = 0.0004; OR = 28.46; 95% CI: 11.53-70.35). Conclusion: Migraine is one of the most common types of primary headache. There is a female preponderance. Migraine has significant association with visual disturbances and ocular symptoms.

Demographic characteristics and visual status of patients undergoing cataract surgery at a tertiary hospital in Kano, Nigeria.

Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. METHODS: The study adhered to the tenets of the Helsinki declaration. Written informed consent was obtained from all eligible patients. All patients underwent basic eye examination by the ophthalmologist. Visual impairment was determined for each eye according to the standard WHO categorizations. Information obtained also included age, sex and history of previous cataract surgery. Data were recorded in manual tally sheets and on modified computer Cataract Surgery Record forms. Analyses were done using SPSS (version 16, SPSS Inc., Chicago, USA). RESULTS: The participation rate was 91.2%. There were 495 eyes of 487 consecutive patients. This include 212 males and 275 females (M:F, 1:1.3). The age range was 40 to 99 years with a mean age of 62.76 ± 10.49 years (61.35 ± 9.75 years in men and 63.85±10.9 years in females). Most of the patients (n = 451; 92.6%, 95% CI: 89.9-94.6%) were aged 50 years and above. Sixty patients (12.3%, 95% CI: 9.6-15.5%) had cataract in both eyes, 427 (87.7%, 95% CI: 84.5-90.3%) were in one eye. Among these, preoperatively 16 (3.3%, 95% CI: 2.0-5.3%) had aphakia, 21 (4.3%, 95% CI: 2.8-6.5%) had uniocular pseudophakia. About 63.2% (95% CI: 58.9-67.4%) of patients had normal vision in the better eye (presenting VA ≥6/18). Overall 9.5% (95% CI: 7.3-12.7%) were bilaterally blind. About 96.8% of eyes (95% CI: 94.5-98.0%) undergoing cataract surgery were blind (presenting VAConclusion: The study highlights preponderance of females and high incidence of blinding cataract. Education and early disease awareness may play an important role in these patients and could improve cataract surgical services in our hospital..

Pattern and outcome of surgical management of nasolachrymal duct obstruction in children: a five year review.

OBJECTIVE: To determine the pattern of naso-lachrymal duct obstruction (NLDO) and outcome of dacryocystorhinostomy (DCR) in children in Aminu Kano Teaching Hospital Kano, over a 5-year period. PATIENTS AND METHODS: The clinic and theater registers were used to retrieve the records of all patients below the age of 15 years who presented with NLDO. The information obtained included age, sex, duration, and types of clinical signs at presentation cause of obstruction and outcome of DCR. Successful outcome is defined as patent naso-lachrymal duct 1 year after surgery. All the patients had external DCR with stent inserted into the lachrymal sac and anchored to the columella and left in situ for 6 weeks. Fortnightly for three visits then at 2 months intervals. At each visit, the patient had lachrymal punctal cannulation and irrigation with normal saline to ensure free drainage. RESULTS: There were 17 patients, 9 males and 8 females (M: F = 1.1: 1). Two patients (11.8%) had bilateral disease and 15 (88.2%) were unilateral. The patients' ages ranged between 2 and 10 years. The commonest presenting features were tearing and discharge. In 14 patients (82%) tearing started from birth though patients presented much later. Congenital NLDO occurred in 82%, and in the remaining 18%, obstruction was caused by depressed nasal fracture. Fifteen patients (88%) had successful outcome of DCR at 1-year follow-up. The commonest complication noted was stent extrusion before 6 weeks in 17.6% of cases. Conclusion : NLDO was mostly of congenital origin and was characterized by delayed presentation. Patients have good outcome with external DCR.

Macular volume and central foveal thickness measurements in normal eyes of healthy Nigerian adults using optical coherence tomography.

OBJECTIVE: To determine macular volume and central foveal thickness measurements in normal eyes of healthy Nigerian adults using Stratus optical coherence tomography. SUBJECTS AND METHODS: Consenting 100 adults Nigerians with normal eyes were recruited and examined using Carl Zeiss Stratus Optical Coherence Tomographer (OCT) machine Model 3000 software version 4.0. A fast macular thickness map scan protocol was employed. Central fovea is defined as locus of intersection of the radial scans. A default setting of six lines at 6 mm was used. Data was analyzed using the paired t-test for independence and linear regression. RESULTS: There were 200 eyes of 100 subjects with mean age of 36.4 + 11.7 years (M: F = 3.3:1). The mean macula volume was 6.79 + 0.392 µm 3 . It was 6.861 ± 0.297 in males, 6.496 ± 0.520 in females and was statistically higher in males than females (P = 0.000). The mean central foveal thickness (MCFT) was 149.58 ± 32.470 µm. It was 154.49 ± 34.652 µm in males and 133.33 ± 15.315 µm in females. MCFT was significantly higher in males than females (P = 0.000). CONCLUSION: Normal macular volume and central foveal thickness measurements in Nigerian adults is presented and is comparable to that of Indian and Chinese populations, but lower than reported in Caucasians.

Epidemiological properties of primary open angle glaucoma in Nigeria.

Background. Primary open angle glaucoma (POAG) is progressive chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage. POAG is the second commonest cause of avoidable blindness in Nigeria. Pattern of Presentation. POAG is characterized by late presentation. Absence of pain which is a driving force for seeking medical help, inadequacy of trained eye care personnel, paucity of facilities, misdistribution of resources, lack of awareness, poor education, and poverty may all contribute to this. Medical and surgical treatment options available are challenging and tasking. Screening for Glaucoma. Screening is the presumptive identification of unrecognized disease (POAG) by applying test(s) which can be applied rapidly. Such test(s) should be of high reliability, validity, yield, acceptable, and cost effective. The test should ideally be sensitive, specific, and efficient. It is difficult to select a suitable test that meets these criteria. Intraocular pressure (IOP) appears to be the easiest option. But, high IOP is not diagnostic nor does normal value exclude the disease. Health education is a possible strategy in early case detection and management. Treatment of POAG. Glaucoma treatment can either be medical or surgical (this includes laser). Considering unavailability, potency, cost, and long-term effects of medication, surgery (trabeculectomy) could be a better option. Laser trabeculoplasty is available in a few centers. Viscocanalostomy is not routinely performed. Patient education is vital to success as management is for life. Conclusion. POAG remains a cause of avoidable blindness in Nigeria. There is need for long-term strategy to identify patients early and institute prompt management. Improvement in training of eye care personnel and provision of up to date equipment is essential in achieving this goal.

Disease pattern and social needs of street people in the race course area of Kano, Nigeria.

PURPOSE: The study is aimed at examining street people on Race Course Street in Kano, Nigeria for prevalence of common diseases. STUDY DESIGN: Descriptive report. SUBJECTS AND METHODS: Institutional ethical approval was obtained. Information was obtained on age, sex, place of residence, drug habits, source of drinking water, toilet facility used, visual acuity, blood pressure, random blood sugar level, presence of skin diseases and physical disability. RESULTS: Sixty five subjects were examined and 7 declined. There were 16 males and 49 females (M:F=1:3). The mean age was 48 + 9.2 years. They were mainly widows, some live in the street and have no access to basic amenities and six use non-narcotic medicinal substances. Diseases observed are hypertension, visual problems, and trauma. CONCLUSION: Religious factors, socio-cultural factors, and lack of government policy leads to poor access to health care for street people.

Clinicopathological pattern and management of retinoblastoma in Kano, Nigeria.

BACKGROUND: The aim of the study is to evaluate the pattern of presentation and the mode of management of retinoblastoma seen in Aminu Kano Teaching Hospital, Kano from 2001 to 2005. MATERIALS AND METHODS: The clinic register was used to obtain the case folders of all children treated for retinoblastoma and this was used to obtain information on patient's age, sex, and clinical sign(s) at presentation such as orbital mass, leucocoria, proptosis, hyphaema without history of trauma, unexplained hypopyon, or uveitis. Also documented were X ray/B mode ultrasound scan findings, type of surgery performed, histological diagnosis, and adjuvant chemotherapy where applicable. RESULTS: Forty-two patients were reviewed, 15 males and 27 females (M: F = 1.0: 1.8). The age ranged between 2 and 6 years and the peak age of presentation was 3 years in 22 patients (52%). The tumor was unilateral in 40 patients (95%) and bilateral in 2 patients (5%). Most of the patients (46%) presented late with fungating orbital mass. Other signs include leucocoria 22%, proptosis 19%, hyphema 7%, Hypopyon 2%, squint 2%, and buphthalmos 2%. Thirty-one patients (74%) had exenteration and enucleation was performed in 11 patients (26%). The tumor was histologically confirmed in 41 patients (98%) and was poorly differentiated in 23 patients (55%), 1 patient (2%) had toxocara granuloma. Thirty-nine patients required adjuvant chemotherapy and only 2 received 6 (full) courses. CONCLUSION: Retinoblastoma, a treatable tumor is characterized by late presentation as illustrated in our study. There is need to create public awareness and educate mothers on this tumor so that there is early diagnosis, appropriate referral, and prompt treatment. The goal is to increase number of children successfully cured of this disease in our environment.